Provider Demographics
NPI:1427791839
Name:KEITH YAMAMOTO
Entity type:Organization
Organization Name:KEITH YAMAMOTO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:YAMAMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:DISPENSING OPTICIAN
Authorized Official - Phone:808-591-8540
Mailing Address - Street 1:1050 S KING ST # 609
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-2114
Mailing Address - Country:US
Mailing Address - Phone:808-591-8540
Mailing Address - Fax:808-591-8541
Practice Address - Street 1:1050 S KING ST # 609
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-2114
Practice Address - Country:US
Practice Address - Phone:808-591-8540
Practice Address - Fax:808-591-8541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site